HEDIS Measures Explained: A Guide for Practice Operations Teams
Understand the terms, reporting context and operational handoffs behind HEDIS, then find the correct measure-year resources.
That last detail is easy to miss. A message asking for "2026 HEDIS records" is not a complete instruction. The team still needs to know which measure is involved, what period is being evaluated and where the supporting information should go. This guide explains the terms needed to have that conversation without turning a measure summary into a clinical protocol.
What does HEDIS describe, and who uses it?
HEDIS describes performance across healthcare topics. A measure may concern prevention, chronic conditions, access, experience or utilization. The current set and its technical resources are available through NCQA. Use the official measure library to establish what a named measure covers. NCQA measures and technical resources
For a practice, a useful way to approach a HEDIS request is to ask who is asking and why. Is a health plan requesting records for reporting? Is the quality team reviewing a patient list? Is a contract owner checking performance against an incentive arrangement? Those questions require different follow-up even when the same measure name appears.
HEDIS results also appear within broader rating systems. NCQA's Health Plan Ratings combine measure ratings with other specified elements, including accreditation status. CMS maintains its own Medicare Part C and D performance and Star Ratings resources. These are separate program references, so a team should not use "HEDIS score," "NCQA rating" and "CMS Star Rating" as interchangeable labels. NCQA Health Plan Ratings 2026, CMS Part C and D performance data
For questions about payment, bring the actual contract or program terms to the responsible owner. A measure's inclusion in HEDIS does not, by itself, describe a practice's incentive arrangement.
How do measurement year, reporting year and rating year differ?
The measurement year identifies the period being assessed. Submission dates describe when the resulting data must be sent through the applicable reporting process. A rating or data product may carry a separate release-year label. Read the labels together rather than assuming that the year in a document title answers all three questions.
NCQA's published MY 2026 submission timeline provides a concrete example: it spans September 2026 through October 2027, with finalized nonsurvey HEDIS results scheduled for submission in June 2027. The same timeline labels Quality Compass products as 2027 products containing MY 2026 data. These are dates in that NCQA process, not a universal practice-level deadline. NCQA MY 2026 data submission timeline
Use this reference card when a request arrives:
| Label to record | Question it answers | What to attach to the request |
|---|---|---|
| Program or requesting organization | Who will use the information? | The named plan, program or internal reporting owner |
| Measure and version | What is being evaluated? | The exact identifier and applicable specification |
| Measurement year or period | Which period does the result describe? | The period stated in the relevant reference |
| Submission date | When does this recipient need the information? | The applicable submission instructions |
| Rating or publication label | Which published result is being discussed? | The named rating system and methodology |
This is an organizational aid, not a substitute for a specification. If a request is unclear, return the missing question to its owner before building a list or changing a report.
How should a team read a measure at a conceptual level?
Start with its purpose, then its population and calculation. For a proportion measure, the denominator describes the eligible population and the numerator identifies the subset meeting the stated criteria. The applicable specification determines the details, including exclusions and the evidence that can be used. Do not assume every HEDIS result is a simple count of patients who received a service. NCQA's technical specifications cover collection, calculation and sampling. NCQA technical resources
A useful handoff note can be brief: "This request concerns this measure and year; this source defines it; this person can answer questions about the specification." The note should point to the rule, rather than reproduce a shortened rule that might lose an exception.
Also identify the reporting method. NCQA describes Electronic Clinical Data Systems, or ECDS, as a standard for collecting and reporting electronic clinical data for HEDIS measurement. Eligible systems can include EHRs, registries, health information exchanges and administrative systems. ECDS does not simply mean "whatever appears in our EHR." NCQA ECDS reporting guidance
For a broad orientation to electronic clinical quality measures, the eCQI Resource Center explains how those measures use electronically extracted clinical information. Keep the specific program and measure instructions alongside that general explanation. eCQI introduction to eCQMs
Measure identified, handoffs unclear? Book a demo to see how Linear moves a flagged record to outreach and an assigned next step.
What can operations teams organize?
Operations teams can make the work understandable without making clinical decisions. Start by separating a request for missing information from a request to arrange a service. Give each item an owner and record what that person needs before proceeding.
For records work, identify where the evidence may be held and who is responsible for obtaining or reviewing it. Keep the source and date with the information. When records from different organizations disagree, preserve the question for the reporting or clinical owner rather than quietly choosing the more favorable status.
For outreach, make the approved task explicit. "Contact the patient about the documented next step" is more precise than "close the HEDIS gap." Record the outcome of contact separately from scheduling and service completion. A callback, a booking and a completed service are different events in the workflow.
For reporting, keep a small change log: which definition or source was checked, what the responsible owner decided and which operational instruction changed. The aim is to make the next handoff reproducible, not to create a second unofficial measure manual.
If the uncertainty is what a care gap means in the first place, start with our care-gap definition guide. If the measure is understood and the problem is execution, use the care-gap closure workflow overview.
Where do current definitions and changes belong?
Use the official resource for the question being answered. The measure library helps identify a measure. Technical specifications govern its use. Updates and FAQs clarify particular versions or issues. The latest document on a website is not automatically the applicable document for every reporting period.
For MY 2026, NCQA announced that it released the Volume 2 Technical Update on March 31, 2026. The announcement describes updated specifications and supporting resources, including value sets, medication lists and risk-adjustment tables. Teams working on that year should check the applicable update rather than rely only on an earlier summary. NCQA MY 2026 Technical Update announcement
Keep the level of detail appropriate to the task. A practice leader needs to know which reference and owner to consult. A qualified reporting specialist needs the applicable specifications. A clinician needs the relevant evidence and patient context. A general blog table cannot perform all of those jobs.
For a year-specific orientation, our HEDIS measures list for 2026 is a separate reference. Verify its details against NCQA before using a measure operationally. For UDS reporting, use HRSA's own reporting guidance; do not assume a similarly named item uses identical reporting rules.
How should a practice use the right reference before acting?
Choose one current request and work through the reference card above. If the measure or year is missing, clarify it. If the request points to an old file, ask the reporting owner which version applies. If a clinical question is embedded in the task, make that handoff explicit.
Then identify the operational obstacle. Perhaps the record has not arrived, the request has no owner or a status does not explain what happened. Solve the obstacle you can name. There is no need to assume a standard outreach conversion rate or a universal staffing ratio to begin.
For software evaluation, first describe the approved workflow and the information it needs. Then use our care-gap software buyer's guide to frame the evaluation. This keeps the purchasing discussion connected to a defined job rather than a promise of an unspecified "HEDIS lift."
Ready to turn care-gap lists into completed outreach? Book a demo.
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Frequently asked questions
What does HEDIS mean?
Who uses HEDIS measures?
How does measurement year differ from reporting year?
Where can a practice find current specifications?
What can operations staff do without making clinical decisions?
Sources
Sources accessed October 12, 2026. NCQA pages describe NCQA's own programs; the CMS, eCQI and HRSA pages describe their respective programs.
- NCQA: HEDIS overview
- NCQA: HEDIS Measures and Technical Resources
- NCQA: HEDIS MY 2026 Data Submission Timeline
- NCQA: MY 2026 Volume 2 Technical Update announcement
- NCQA: HEDIS Electronic Clinical Data Systems Reporting
- NCQA: Health Plan Ratings 2026
- CMS: Part C and D Performance Data
- eCQI Resource Center: About Electronic Clinical Quality Measures
- HRSA: UDS Reporting Guidance